OCFS-5003 – County of Saratoga, New York

NEW YORK STATE
OFFICE OF CHILDREN AND FAMILY SERVICES
INDIVIDUAL PROGRAM APPLICATION
Program Summary-Program Components
Please follow the Program Summary-Program Components (OCFS 5003) Instructions

Implementing Agency

Program Title

Life Area

Goal

Objective

Services, Opportunities and Supports

PERFORMANCE MEASURES

How Much

How Well

Better Off

GENDER OF PROGRAM PARTICIPANTS, ETHNICITY AND AGES

Enter number of participants per gender

Male

Female

Enter number of participants per ethnic group

White

Black or African American

Asian

Hispanic or Latino

Native Hawaiian or Pacific Islander

American Indian or Alaskan Native

Two or more Races

Enter number of participants per age group

0-4

5-9

10-14

15-17

18-20

21+

IS TARGET POPULATION SERVING DISCONNECTED YOUTH:
Yes No

Enter number of participants per population described

Youth aging out of foster care

Youth in the juvenile justice system who re-enter the community

Children of incarcerated parents

Runaway and Homeless Youth

IF APPLICABLE

Objective

Services, Opportunities and Supports